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1901 GILBERT STU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Jon Myers Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1901 Gilbert Street Company NAIC Number: City State ZIP Code Clearwater Florida 34698 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 85 Bay Aristocrat Village, 18675 US Highway 19 N, Clearwater, Fl ID20-29-16-032090-000-0850 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Lat. 27 deg 5612" N Long. 82 Accessory, etc.) deg 42 45" W Horizontal Datum: El obtain flood insurance. 1.0 foot above adjacent above adjacent grade NAD 1927 grade K1 NAD 1983 2 photograph the building if the Certificate Numbe is being used to sq ft a crawl of crawispace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? ace enclosure(s): or endosure(s) openings in the crawlspace in A8.b sq or endosure(s) within in ft within 1.0 foot sq in 0 Yes 0 No garage: garage sq openings in the attached garage in A9.b Ei Yes 0 No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G Be, FIRM Index Date B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) X B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) B10. Indicate the source 0 FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) 2) FIRM 0 Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources 0 CBRS data 0 NGVD System or base flood depth entered in Item B9: 0 Other/Source: 1929 El NAVD 1988 0 Other/Source: (CBRS) area or Otherwise Protected Area (OPA)? 0 OPA 0 Yes Z No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 w w-eclaw. i wirUt I ILIGI •J‘J, wLV IC IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1901 Gilbert Street Policy Number: City State ZIP Code Clearwater Florida 34698 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V Complete Items C2.a—h below according to the building diagram specified Benchmark Utilized: Vertical i2 building (with Datum: Building Under Construction* Li Finished Construction is complete. BFE), AR, ARIA, AR/AE, AR/A1—A30, AR/AH, AR/AO. in Item A7, In Puerto Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 NAVD 1988 El Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawispace, or enclosure floor) . El feet 0 meters b) Top of the next higher floor 0 feet 0 meters c) Bottom of the lowest horizontal structural member (V Zones only) 0 feet 0 meters d) Attached garage (top of slab) El feet 0 meters e) Lowest elevation of machinery or equipment servicing the building 0 feet 0 meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 0 feet 0 meters g) Highest adjacent (finished) grade next to building (HAG) . 0 feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including . 0 feet 0 meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? [E Yes 0 No 0 Check here if attachments. Certifiers Name License Number David F Ramsey 15307 .,„,,,;$6.;„„ `...trtic..1Z 0A".• . Title Professional Engineer , ,.. •,/ , Do.o••••... .- .-:.:' •1' e Ey tel -.- v -:!) -... Company Name R&S Engineering and Construction Corp I tp° : c) 4 ace ,, -,, .7. :: ic: 4 Seal 4 ' : ! • . . (0 Address 434 Skinner Boulevard, Suite 105 - ' : " Here ' •Cfd .- 4,7 (Sr ; , -. ''.. '-;•‘• ' N.: ,, to? City State ZIP Code Dunedin Florida 34698 '• '.. .-.. '-, , ':,.. . 4- r „• .. ',..1--. ,,,,.00*• ''" .'''44JEE n Signa e Date Telephone 01/12/2017 (727) 409-4639 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) buildirtk owner. Comments (including type of equipment and location, per C2(e), if applicable) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Jon Myers A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 1901 Gilbert Street City State ZIP Code Clearwater Florida 34698 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 85 Bay Aristocrat Vllage, 18675 US Highway 19 N, Clearvvater, FI ID20-29-16-032090-000-0850 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27 deg 56'32" N Long. 82 deg 42' 45" W Horizorrtal Datum: � NAD 1927 � NAD 1983 A6. Attach at least 2 photograph the butlding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Numbe � A8. For a building with a crawl ace enGosure(s): a) Square footage of crawlspace or enGosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑ Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? � Yes � No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name B3. State 125096 Pinellas Florida 64. Map/Panel 85. Suffix B6. FIRM Index 67. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12103C0128 G 09/03/2003 X 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: � FIS Profile � FIRM ❑ Community Determined � Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 � OthedSource: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes � No Designation Date: � CBRS ❑ OPA FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 1 of 6 .' ELEVATION CERTIFICATE OMB No. 1660-0008 Eupiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 1901 Gilbert Street City State ZIP Code Company NAIC Number Clearwater Florida 34698 SECTION C— BUILDING ELEVATION INFORMATtON (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* � Building Under Construction! � Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1 A30, AE, AH, A(with BFE), VE, V1—V30, V(with BFE), AR, AR/A, AR/AE, AR/A1�30, AR/AH, AR/AO. Complete ttems C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Vertical Datum: Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Chedc the measurement used. a) Top of bottom floor (inGuding basement, crawlspace, or enclosure floor) ❑ feet ❑ meters b) Top of the next higher floor . ❑ feet � meters c) Bottom of the lowest horizontal structural member (V Zones only) . � feet � meters d) Attached garage (top of slab) . ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building . ❑ feet ❑ meters (Describe type of equipment and location in Comments) � Lowest adjacent (finished} grade next to building (LAG) ❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) � feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including ❑ feet � meters structural support SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpref fhe data available. I understand ti►at any fa/se statement may be punishable by fine or imprisonmenf under 18 U. S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No ❑ Check here if atta�hments. Certifier's Name License Number David F Ramsey 15307 �' '�;��"�� Title �,, ��j'���' ,��r�'�f�': PPOf2SS1011'd� EIIC,JIf18@P ,���� ��abor+•�a��o� �J � _ ,�'G•y � "; ��j L' �, ••� ;��� � Company Name � ' R&S Engineering and Construction Corp 2?�' ��'` $eal �� x� �� Address = '' y t$" ; Here � �=` � �� 434 Skinner Boulevard, Suite 105 �'� °�� t,`� Q; �' City State ZIP Code �✓• ,s��•.�� Q ��,. ° r� Dunedin Florida 346gg . ' i���s •^m•••a`�� ��s Signat e Date Telephone �•�.,, , „ ,.,,s� 01 /12/2017 (727) 409-4639 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3)� bu�ldr� i�iwner. Comments (including type of equipment and location, per C2(e), if applicable) rcmH rorm uut�-U-�s (/n5) Replaces all previous editions. Form Page 2 of 6 �` _ � �.